B.S. in Pharmacy with experience or Doctor of Pharmacy
Current U.S. pharmacist license
Experience in PBM, Pharmaceutical and Healthcare industry
Experience with Pharmaceutical Contracts and Pharmacy Benefits strongly preferred
Experience with clinical utilization criteria evaluation strongly preferred
Excellent presentation and communication skills required
Successfully function while handling multiple tasks and ability to prioritize
Detail-oriented with strong organizational skills
Ability to adapt in a dynamic work environment and learn quickly, solve problems, and make decisions with minimal assistance or direction from leader when interfacing with clients and other internal partners
Ability to work independently and prioritize work to meet client needs
Proficiency in Microsoft Office applications required
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
For this position, we anticipate offering an annual salary of 95,500 - 159,100 USD / yearly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
About Evernorth Health Services
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related med
Benefits
Health insuranceDental insuranceVision insurance401(k)Performance bonus
Additional Information
This is a Hybrid position (3 days per week in-office + 2 days work at home). The incumbent candidate can be based out of any US Cigna Healthcare office and is not restricted to locations that are listed in this posting.
POSITION SUMMARY
The Clinical Program Advisor will be responsible for review, consultation, and clinical evaluation of utilization management criteria to align with pharmaceutical rebate contract requirements and providing quality assurance evaluations that will promote accurate rebate invoicing. This role will work cross-functionally with the Pharmaceutical Contracting, Clinical Consulting, and Pharmaceutical Invoicing teams to ensure formulary tier and clinical rules are interpreted correctly and will evaluate benefit set up impacts on rebated drug products. Reporting to the Clinical Program Director, this position provides clinical support in documenting formulary placement/positioning and utilization management policies and procedures for the analysis and appropriate determination of client eligibility for rebate enhancement and exclusion options. Additionally, this role offers consultative clinical support in the interpretation of rebate requirements contained within manufacturer rebate agreements, as well as advice regarding impact assessments following any proposed or implemented changes to formulary tiers, contracts, or management policies. Additional responsibilities include acting as a point of contact for client's clinical and formulary-related initiatives, completing financial/rebate impact assessments to evaluate utilization management strategies, conducting ongoing formulary maintenance and new formulary implementation reviews, and identifying prospects for clinical program adoption.
ESSENTIAL FUNCTIONS
Support client with formulary, rebate, and utilization management strategies to service all current and future needs
Participate in Clinical Program team functions, including maintaining formulary status changes for all actively maintained formularies, assessing utilization management policy updates, and consulting on anticipated clinical and financial impacts of strategies under consideration by the client
Keep abreast with industry pipelines, such as new drugs, patent expirations, generic and biosimilar approvals and launch dates, etc.
Act in concert with internal teams, such as Account Management to service all needs of the client
Participate in developing tools and trainings for carrying out work plan goals, including continuous process improvement activities
Represent the strategic market division as a point of contact for various corporate clinical initiatives, including participation in client meetings
Cigna · St. Louis, MO